Healthcare Provider Details

I. General information

NPI: 1922660083
Provider Name (Legal Business Name): EXMAN PSYCHOLOGICAL SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2019
Last Update Date: 06/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 CLEVELAND AVE N STE 400
ARDEN HILLS MN
55112-3297
US

IV. Provider business mailing address

5123 253RD AVE NW
ISANTI MN
55040-4203
US

V. Phone/Fax

Practice location:
  • Phone: 651-362-0155
  • Fax:
Mailing address:
  • Phone: 651-343-3025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. AMANDA EXMAN
Title or Position: PSYCHOLOGIST
Credential: PSY.D.
Phone: 651-362-0155